Implant components and methods

ABSTRACT

Systems, devices, and methods are provided for orthopedic implants. The implants may include a base member, such as an acetabular shell or an augment, that is configured to couple with an augment, flange cup, mounting member, or any other suitable orthopedic attachment. An augment provided for an acetabular implant may be adjustably positionable around the implant. An implant may have one or more slots that mate with connections on the augment and allow the augment to move within the slot. An augment may be translated, rotated, or moved in any other way to achieve a desired orientation prior to locking the augment in place relative to the implant. The augment may be locked by a screw or other locking mechanism that holds the augment in place. The locking mechanism may be releasable to allow for repositioning of the augment.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional PatentApplication No. 61/352,705, filed Jun. 8, 2010, U.S. ProvisionalApplication No. 61/352,722, filed Jun. 8, 2010, U.S. ProvisionalApplication No. 61/422,903, filed Dec. 14, 2010, and U.S. ProvisionalApplication No. 61/466,817, filed Mar. 23, 2011, which are herebyincorporated by reference herein in their entireties.

BACKGROUND

Joints often undergo degenerative changes due to a variety of reasons.When joint degeneration becomes advanced or irreversible, it may becomenecessary to replace the natural joint with a prosthetic joint.Artificial implants, including hip joints, shoulder joints, and kneejoints are widely used in orthopedic surgery. Specifically, hip jointprostheses are common. The human hip joint acts mechanically as a balland socket joint, wherein the ball-shaped head of the femur ispositioned within the socket-shaped acetabulum of the pelvis. Variousdegenerative diseases and injuries may require replacement of all or aportion of a hip using synthetic materials, typically metals, ceramics,or plastics.

More particularly, natural hips often undergo degenerative changes,requiring replacement of the hip joint with a prosthetic joint. Often,the hip is replaced with two bearing surfaces between the femoral headand the acetabulum. The first bearing surface is typically a prosthesisshell or acetabular cup, which may be formed of metal, ceramic material,or as otherwise desired. A liner (conventionally formed of polyethylenematerial such as ultra high molecular weight polyethylene, a ceramicmaterial, or in some cases, even a metal liner) is then fit tightlywithin the shell to provide an inner bearing surface that receives andcooperates with an artificial femoral head in an articulatingrelationship to track and accommodate the relative movement between thefemur and the acetabulum.

The cup (or a cup and liner assembly) is typically fixed either byplacing screws through apertures in the cup or by securing the cup withcement. In some cases, only a liner is cemented in a patient due to poorbone stock. In other cases, a cup having a porous surface may be pressfit into the reamed acetabular surface.

It may become necessary to conduct a second or subsequent surgery inorder to replace a prosthetic joint with a (often larger) replacementjoint. Such surgeries often become necessary due to further degenerationof bone or advancement of a degenerative disease, requiring removal offurther bone and replacement of the removed, diseased bone with a largeror enhanced prosthetic joint, often referred to as a revisionprosthesis. For example, bone is often lost around the rim of theacetabulum, and this may provide less rim coverage to securely place apress-fit cup. Such surgeries may thus be referred to as revisionsurgeries.

In acetabular revision surgery, an acetabular prosthesis generallyincludes additional mounting elements, such as augments, flanges, hooks,plates, or any other attachment or mounting points or members thatprovide additional support and/or stability for the replacementprosthesis once positioned. These additional mounting or attachmentmembers are often required due to bone degeneration, bone loss, or bonedefects in the affected area (in this instance, the hip joint).

Various types of these mounting members (which term is intended toinclude but not be limited to flanges, blades, plates and/or hooks) maybe provided in conjunction with a prosthesis system in order to help thesurgeon achieve optimal fixation, non-limiting examples of which includeiliac flanges (providing securement and fixation in and against theilium region of the pelvis), ischial blades (providing securement andfixation in and against the ischium), and obturator hooks (providingsecurement and inferior fixation by engaging the obturator foramen).Although there have been attempts to provide such mounting attachmentswith modularity, the solutions to date have generally fallen short ofproviding true modularity. Instead, they typically provide a fewdiscrete positions at which the mounting members may be positioned,without providing the surgeon a fuller range of decision options.

Additionally, in some primary surgeries and more often in revisionsurgeries, the acetabulum may have a bone defect or void that thesurgeon must fill with bone grafts before inserting a new shell. Thiscan be time consuming and expensive, and may subject the patient toadditional health risks. Some techniques use an augment in connectionwith the acetabular shell, which can be coupled to or otherwise attachedto the outer surface of the shell.

With current augments, the surgeon can attach the augment to the boneand then implant the cup. However, many acetabular shells rely on bonescrews to achieve proper fixation and the augment often gets in the wayof a screw. In short, surgeons need the freedom to place screws in thebest location, but this compromises their ability to use augments. Withcurrent systems, it also takes an increased amount of time surgical timeto trial the component orientation and then try to find good bonefixation for the cup. The surgeon will often have to free-hand theamount of bone removed while estimating the size of augment needed. Inthe cases where bone is often deficient, surgeons are hesitant to takeaway any more bone than necessary.

Various additional features and improved features intended for use andapplication with various types of joint implants are also describedherein, such as improved bone screws, improved coatings, and variousaugment removal and insertion options.

SUMMARY

Disclosed herein are systems, devices, and methods for providing modularorthopedic implants. The implants may include a base member, such as anacetabular shell or an augment, that is configured to couple with anaugment, flange cup, mounting member, any other suitable orthopedicattachment, or any combinations thereof. Mounting members include, forexample, flanges, blades, hooks, and plates. In some embodiments, theorthopedic attachments may be adjustably positionable about the basemember or other attachments thereby providing modularity for assemblingand implanting the device. Various securing and/or locking mechanismsmay be used between the components of the implant. In certainembodiments, the orthopedic attachments are removably coupled to thebase member or other components. In certain embodiments, the orthopedicattachments are integrally provided on the base member or othercomponents, yet may still be adjustably positionable thereabout. In someembodiments, expandable augments, base members, or other bone fillingdevices are provided. In some embodiments, surface features are providedthat create friction and allow for surrounding bone ingrowth at theinterface of the implants and a patient's bone.

Systems, devices, and methods described herein provide implants havingaugments configured to attach to acetabular shells or cages, mountingmembers, or other augments with or without cement and configured toallow fine positional adjustments for best bone fit, coverage, andstability. In certain embodiments, an orthopedic implant includes anacetabular implant having a track that includes a plurality of slots andan exterior surface, an augment having a protrusion that moves withinthe plurality of slots, the augment having a first cam surface thatforms an interface with the exterior surface, where the protrusion hasan adjustable fastener that, upon adjusting, fixes the augment withrespect to the implant to impede further movement. In some embodiment,the augment may rotate about the exterior surface. The adjustablefastener may be a tightening screw that extends through a through-holein the augment and, upon tightening, expands the protrusion (which maybe flared outwardly) and thereby tightens the augment within the track.In some embodiments, the tightening screw has a head that fits within aslot and faces an interior portion of the implant, where the slot has aninterior opening that aligns with the head, and where the interioropening receives a tightening rod to tighten the screw. In someembodiments, the track includes a dovetail joint that receives theprotrusion. In some embodiments, the track includes a straight portionand a curved portion. For example, the track can include two straightslots and a curved portion. In some embodiments, the track includes aJ-shaped slot with a wall of the implant. The protrusion may be part ofan intermediate locking member that is integral to the augment. In someembodiments, the first cam surface of the augment includes at least onetrough that receives cement to bind the augment to the shell. In someembodiments, the augment includes a plurality of projections that form agap and may further include a flange attached to the augment.

In certain embodiments, a method of preparing an orthopedic implantincludes the steps of providing an implant having a curved externalsurface and an opening in the surface, the opening having at least twoportions that join at a common region but are separated by an angle ofless than 180°, providing an augment having a first surface thatinterfaces with the curved external surface, coupling the augment andimplant by an intermediate locking member, and tightening theintermediate locking member. In some embodiments, the method may furtherinclude the step of securing the augment to the implant by disposingcement within a trough located on the first surface. In someembodiments, the method may further include the step of rotating theaugment with respect to the implant about the curved external surfaceprior to tightening the intermediate locking member, and moving theintermediate locking member within the opening prior to tightening. Insome embodiments, the method may further include the steps of applying afastener to the implant, so that the fastener extends outwardly from theexternal surface, and positioning the augment about the external surfaceso that the extended fastener fits between two protrusions of theaugment, where the intermediate locking member is tightened with respectto the augment by a screw.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects and advantages will be apparent uponconsideration of the following detailed description, taken inconjunction with the accompanying drawings, in which like referencecharacters refer to like parts throughout, and in which:

FIG. 1 shows an illustrative augment configured to attach to acetabularshells or cages, mounting members, or other augments;

FIGS. 2 and 3 show an illustrative acetabular shell or cage thatincludes a track;

FIG. 4 shows an illustrative augment that includes a through hole;

FIG. 5 shows an illustrative fastener having an expanding portionconfigured to be inserted through a track on an acetabular shell andinto an augment;

FIGS. 6 and 7 show illustrative augments configured to secure to anacetabular shell or cage, mounting member, or other augment prior toinsertion into a prepared bone void;

FIG. 8 shows an augment having an illustrative intermediate adaptermember;

FIG. 9 shows an illustrative insertion opening in a shell adapted toreceive features of the intermediate adapter system of FIG. 8;

FIG. 10 shows an illustrative expansion member inserted into anintermediate adapter member to secure the adapter in a desired location;

FIGS. 11 and 12 show examples of a prior mounting member or augmentadapted for securement to a shell;

FIGS. 13-15 show an illustrative mounting member or augment providedwith an opening having multiple fixed directional threaded screw holes;

FIG. 16 shows an illustrative mounting member or augment having anexpandable or deformable spherical ball member;

FIG. 17 shows an illustrative mounting member or augment having arotatable inner cylinder insert member;

FIG. 18 shows an illustrative mounting member or augment similar to FIG.17 that is configured for use with a polyaxial fastener;

FIG. 19 shows an illustrative mounting member and an illustrativeaugment member provided with a dovetail feature;

FIGS. 20 and 21 show an illustrative dovetail feature configured toreceive a fastener;

FIGS. 22 and 23 show an illustrative chock distally-connected to asurgical cable and positioned within a portion of an augment;

FIGS. 24 and 25 show an illustrative chock having an angled or inclinedsurface configured to receive an expansion member;

FIG. 26 shows an illustrative cable tensioning device provided on amounting member or augment;

FIGS. 27-29 show an illustrative mounting member or augment that may beattached to an acetabular shell, cage or other augment using a separateexpandable chock member and an intermediate connecting member;

FIG. 30 shows an illustrative expanding element that may be provided inan aperture of a mounting member or augment;

FIG. 31 shows an illustrative ferrule on a cable that may be positionedagainst an augment;

FIGS. 32 and 33 show illustrative geometries for a receiving portion ofa shell, cage, or augment;

FIG. 34 shows illustrative indicia for indicating a positionalrelationship between the mounting member or augment and the implant towhich it is to be attached;

FIG. 35 shows illustrative spikes that may be provided on mountingmembers or augments for improving fixation;

FIG. 36 shows an illustrative bi-lobe cup or shell;

FIG. 37 shows two augments attached together via an illustrativefastening device;

FIG. 38 shows an illustrative augment with integral spikes;

FIG. 39 shows an illustrative augment with built-in securement features;

FIG. 40-42 show various illustrative augments or porous coating portionshaving one or more cross-sectional areas of reduced material;

FIG. 43 shows an illustrative rotary tool;

FIGS. 44-47 shows various connection devices for securing a mountingmember or an augment to an acetabular shell or cage;

FIGS. 48-50 show illustrative augments provided with an elongatedundercut groove configured to receive a cam locking pin;

FIG. 51-54 show illustrative cleats provided proximate to a rim of anacetabular shell or cage, mounting member, or augment;

FIG. 55 shows illustrative cleat portions configured for securing softtissues;

FIGS. 56 and 57 show an illustrative augment attached peripherally to anacetabular shell or cage via a recess;

FIGS. 58 and 59 show an illustrative mounting member attachedperipherally to an acetabular shell or cage via a recess;

FIG. 60 shows an acetabular shell or cage having an illustrative annularprotrusion;

FIG. 61 shows a mounting member having an illustrative orthopedic mesh;

FIG. 62 shows an illustrative mesh portion placed on an outer portion ofa shell;

FIG. 63 shows an illustrative mesh that includes a plurality of trimlines that may be cut to separate the mounting members attached thereto;

FIG. 64 shows illustrative separated mounting members from the mesh ofFIG. 63 placed into a patient's hip region; and

FIGS. 65 and 66 show an illustrative honeycomb design that may beprovided on a mounting member or augment.

DETAILED DESCRIPTION

To provide an overall understanding of the systems, devices, and methodsdescribed herein, certain illustrative embodiments will be described.Although the embodiments and features described herein are specificallydescribed for use in connection with acetabular systems, it will beunderstood that all the components, connection mechanisms, adjustablesystems, fixation methods, manufacturing methods, coatings, and otherfeatures outlined below may be combined with one another in any suitablemanner and may be adapted and applied to medical devices and implants tobe used in other surgical procedures, including, but not limited to:spine arthroplasty, cranio-maxillofacial surgical procedures, kneearthroplasty, shoulder arthroplasty, as well as foot, ankle, hand, andother extremity procedures.

Various implants and other devices described herein in their variousembodiments may be used in conjunction with any appropriatereinforcement material, non-limiting examples of which include bonecement, appropriate polymers, resorbable polyurethane, and/or anymaterials provided by PolyNovo Biomaterials Limited, or any suitablecombinations thereof. Further non-limiting examples of potentialmaterials that may be used are described in the following references:U.S. Patent Application Publication No. 2006/0051394, entitled“Biodegradable Polyurethane and Polyurethane Ureas,” U.S. PatentApplication Publication No. 2005/0197422, entitled “BiocompatiblePolymer Compositions for Dual or Multi Staged Curing,” U.S. PatentApplication Publication No. 2005/0238683, entitled “BiodegradablePolyurethane/Urea Compositions,” U.S. Patent Application Publication No.2007/0225387, entitled “Polymer Compositions for Dual or Multi StagedCuring,” U.S. Patent Application Publication No. 2009/0324675, entitled“Biocompatible Polymer Compositions,” U.S. Patent ApplicationPublication No. 2009/0175921, entitled “Chain Extenders,” and U.S.Patent Application Publication No. 2009/0099600, entitled “High ModulusPolyurethane and Polyurethane/Urea Compositions.” Each of the priorreferences is incorporated by reference herein in its entirety.

The embodiments shown in FIGS. 1-15 provide augments that may beconfigured to attach to acetabular shells or cages, mounting members, orother augments without cement, and are also configured to allow finepositional adjustments for best bone fit, coverage, and stability. Itwill be understood that the features and components described inconnection with the augments of FIGS. 1-15 may also be applied tomounting members, such as hooks, flanges blades, or any other suitablemounting members, that may be configured to attach to acetabular shellsor cages, augments, or other mounting members. FIG. 1 illustratescertain embodiments wherein an augment 450 may be placed on a peripheryof a hemispherical acetabular shell, cage, or other augment. As shown inFIGS. 2 and 3, a shell or cage 460 may comprise a track 462 that isundercut so as to form a dovetail joint 461 with a mounting member or anaugment. The track 462 may be provided as a J-shaped slot (as shown),T-shaped slot, H-shaped slot, or any other shape involving combinationsof straight and/or curved segments. The track 462 preferably includes atleast two portions or slots, at least one of which can receive acomplementary connector or protrusion from the augment or mountingmember. As shown in FIG. 2, for example, the first portion or slot 464and second portion or slot 466 join about common region 468 but areseparated out at distal ends 465 and 467 by angle Ø, which is less than180° in the example. The at least two portions thereby permit theaugment or mounting member to be adjustably positioned along the surfaceof the shell, cage, or other augment by sliding the augment (and itsconnector) along the track and securing it at the desired location. Forexample, the augment could be secured in one of the at least twoportions (such as slot 464), or the other of the at least two portions(such as slot 466), or in between.

The mounting member or augment may have a protrusion that is flaredoutwardly, and may be generally frustoconical, bulbous, or otherwiseforms a portion of a male portion of a dovetail joint. For example, asshown in FIG. 1, augment 450 includes protrusion 452 that is flaredoutwardly. The flared protrusion 452 may be expandable when used with acentral mandrel or expanding fastener. Additionally or alternatively, itmay be made from a deformable material and/or may be provided as abifurcated member having one or more leg portions to facilitateexpansion of the protrusion.

The outer peripheral surface portions 453 of the protrusion 452 may berounded (e.g., a frustoconical shape), and the augment 450 (or, in someembodiments, mounting member) may not only be translated within andalong the track 462 on the shell 460, but also rotated within the track462 on the shell 460. A fastener 456 such as a screw, setscrew, mandrel,shank, rivet, or any other fastener having a low profile head which isaccessible from the inside dome portion of the shell or cage 460 (oranother augment) is configured to engage an inner bore or opening 458located in the flared protrusion 452, thereby expanding the protrusion452. The term “expansion member” is used herein to refer to anyappropriate member, including but not limited to the fasteners listedabove, that can be used to engage and/or otherwise expand anotherfeature. One example of an expansion member that may be used inconnection with this embodiment comprises a setscrew/mandrel/fastenerthat has a tapered outer portion or a surface having an outer diameterthat is greater than the receiving portion of the protrusion, such thatwhen the expansion member is threaded into the protrusion, theprotrusion expands. The expansion of the flared protrusion causes theprotrusion to frictionally engage the track in the shell/cage/augment,thereby forming a locked dovetail connection which secures the mountingmember or augment to the shell. Once the expansion member is completelytightened, the mounting member or augment is locked to theshell/cage/augment in both translation and rotation with a strongdovetail locking joint. For example, augment 450 can be attached to thetrack 462 by the protrusion 452. Before tightening the protrusion 452,the augment 450 can be rotated with respect to the shell 460, such thatthe augment interior surface 454 and the shell exterior surface 469remain generally interfaced while the augment 450 rotates about theshell 460 like a cam, until the augment 450 is in the desired position.The protrusion 452 is then tightened to secure the augment 450 in thatposition.

One advantage of such a mechanism is that the assembly of theshell/cage/augment and the mounting member or augment may be looselyassembled, then placed into a bone void such as an irregularly shapedbone void. Once generally positioned, the assembly components may beadjusted with respect to each other to best fit an existing or preparedbone void. The assembly components may then be tightened together suchthat the assembly closely approximates the size, shape, and orientationof the existing or prepared bone void.

While the particular embodiment shown in FIG. 1 illustrates an expansionmember 456 seated in a “blind” interior opening or bore 458 in augment450, an augment may alternatively or additionally comprise a throughhole such as through hole 478 of augment 470 in FIG. 4, configured toreceive an expansion or tightening member 476, for example a long bonescrew, long fastener, or other long expansion member (such a tighteningconfiguration will be referred to throughout as a “long bone screw,” butit will be understood that any appropriate fastener that can secure twocomponents together, while also potentially gain purchase into bone isconsidered appropriate for use in connection with the describedembodiment). The tightening member 476 may be configured to gainpurchase in the augment 470 and/or surrounding bone as illustrated inFIG. 4. The opening 487 in the flared protrusion 472 that receives thebone screw 476 may generally continue through the augment 470 and out ahole 479 in a side of the augment 470 opposite the protrusion 472. Insuch embodiments, the bone screw 476 enters the augment 470 through anopening in the track 462 on the inside surface 463 of the shell/cage 460(or, in some embodiments, another augment), and protrudes through theentire augment 470, including the flared protrusion 472 which, duringinsertion of the bone screw 476, will expand into the undercut track 461on the shell/cage 460. Essentially, the bone screw 476 locks the augment470 to the shell/cage 460 and secures the entire assembly to surroundingbone, thereby stabilizing the assembly with respect to hip anatomy. Inthis sense, not only does the bone screw 476 serve to rigidly secure theaugment 470 to the shell/cage 460 before necessarily securing purchaseof the bone screw 476 into surrounding bone, the bone screw 476 furtherprovides secondary fixation of the assembly to surrounding bone by thensubsequently securing purchase with surrounding bone.

The embodiment shown in FIG. 4 allows a surgeon to lock the augment 470to a second component from an inside portion (e.g., an inside portion463 of a shell 460), after the loose assembly is placed into theprepared bone void. In other words, the augment 470 may be looselycoupled to the shell 460 or other second component in the patient's bonevoid, and a fastener is used to secure the augment to the secondcomponent (not shown, but which may be the shell, cage, or a secondaugment) and to the patient's bone. The head is arranged within the slotof track 462 so that it is aligned with the interior opening 478 of theaugment 470 and extends radially within the shell 460. The surgeon canthen insert a tightening rod through the interior opening 478, frominside the shell 460, to access and tighten the screw 476.

FIG. 5 illustrates some embodiments related to those shown in FIG. 4. Abone screw 681 or other fastener having both an expanding portion 694and a bone engaging portion is inserted through an undercut recess,groove, or track 682 provided on an acetabular shell or cage 680 (or, insome embodiments, provided on an augment). The bone screw 681 or otherfastener may be inserted from an accessible inside portion 683 of saidshell/cage 680. The bone screw 681 or other fastener protrudes into andthrough an opening 684 within an adjacent augment 686 (or, in someembodiments, a mounting member) having a male connection member 688. Themale connection member 688 may be generally cylindrical or flared (e.g.,frustoconical) and is configured to be inserted into and move within(translate, rotate, etc.) the undercut recess, groove, or track 682.

In use, as the bone screw 681 begins to make purchase with bone, theexpanding portion 694 of the bone screw 681 engages a complementaryexpanding portion 692 of the augment 686 adjacent the male connectionmember 688, thereby expanding a portion of the male connection member688 inside the undercut recess, groove, or track 682 and locking theaugment 686 to the shell/cage 680 (or other augment). In someembodiments, one or more of the expanding portions of the bone screw andmounting member or augment may not be threaded. For example, theexpanding portion 694 of the bone screw 681 may be threaded, and theexpanding portion 692 of augment 686 may be a smooth tapered recess.Alternatively, the expanding portion 694 of the bone screw 681 may be asmooth tapered surface that seats within and wedges against a smoothtapered expanding portion bore 684 in the augment 686. The taper angleof the bone screw 681 expanding portion 694 may differ from the taperangle of the expanding portion bore 684. Furthermore, the expandingportion 694 of the bone screw 681 may be an enlarged threaded sectionthat engages with a smooth undersized bore 684 in expanding portion 692of the augment 686.

In further embodiments, as shown in FIGS. 6 and 7, it may be desirableto secure a mounting member or augment to an acetabular shell or cage,or other augment or mounting member prior to insertion into a preparedacetabular bone void. In such instances, the expansion member used toexpand the protrusion may be made relatively shorter, so as to bepartially or completely encased by the mounting member or augment. Forexample, expansion member 486 of augment 480 and expansion member 496 ofaugment 490 may be relatively shorter than bone screw 476 of augment470. The insertion direction of the expansion member may be reversedwith respect to the aforementioned embodiments, and move in a securingdirection which is towards the acetabular shell/cage or other augment.In this way, the mounting member or augment may be attached to theshell/cage or other augment in a predetermined configuration, prior toinsertion of the assembly into the prepared bone cavity.

The embodiment shown in FIG. 6 allows a surgeon to lock the augment 480to the shell 460 prior to insertion into the prepared bone void, outsideof the body cavity. The attachment prior to insertion may be a tightsecurement or a loose coupling. If a loose coupling is desired, suchthat complete securement can be completed once the assembly has beenfully positioned, an opening 499 on an upper surface 494 of the augment490, as shown in FIG. 7 allows tightening once the completed assembly ispositioned in the bone cavity. In other words, this embodiment allows asurgeon to lock the augment 490 to the shell 460 from an outside portionon exterior surface 469 of the shell 460, after the loose assembly isplaced into the prepared bone void.

In use, the surgeon may place a frustoconical or otherwise flaredprotrusion of the mounting member or augment into an insertion clearanceopening in the shell/cage or other augment, and then may move theaugment within a track extending from and connected to the opening (asshown in FIG. 8) to a desired rotational angle and/or location along thetrack. The surgeon may rotate, translate, or otherwise position or movethe mounting member or augment as desired within the track. When theaugment is positioned and located in a desired spatial orientationrelative to the shell/cage or other augment, the expansion member can beinserted into and through the augment, and tightened within a threadedbore located in the protrusion.

It will be appreciated by one having ordinary skill in the art that,while not shown, the expansion member may be internally threaded andengageable with a male thread located within an opening in theprotrusion. It will also be appreciated that, while not shown, theexpansion member may only threadingly engage the bulk body of themounting member or augment and may have a distal wedge portion providedthereon which engages a smooth tapered opening in the protrusion. Inthis embodiment, when the expansion member moves toward the protrusionin threaded engagement with the bulk body of the mounting member oraugment, its distal wedge portion wedges open the flared projection viainclined surfaces without actually “threadably” engaging in innersurface of the protrusion. It should also be noted that the use of otherfasteners such as the rivet-type, or any other suitable fastener, orcombinations thereof, is envisioned.

When the expansion member is tightened or otherwise adjusted, the armsof the bifurcated protrusion expand and move away from each other, andtherefore, the outer flared portions of the protrusion engage theundercut walls of the track provided on the shell/cage/augment. Forexample, when expansion member 456 of FIG. 1 is tightened or otherwiseadjusted, the arms of protrusion 452 may expand and engage the undercutwalls 461 of the track 462 provided on shell 460 of FIG. 2. The arms ofprotrusions 472, 482, and 492 may similarly be expanded when anexpansion member is tightened or otherwise adjusted. Friction betweenthe walls of the track and the expanded bifurcated protrusion maintainthe mounting member or augment in fixed relationship relative to theshell/cage/augment, and the assembly may be inserted into the preparedbony site.

As shown in FIG. 8 and for potential use in connection with orinterchangeably with the embodiments shown in FIGS. 44-47, anintermediate adapter member may be used to secure a mounting member oraugment to an acetabular shell, cage, or other augment. For example,adapter 502 comprises a portion that is received in an opening (e.g.,tapered hole or undercut track) in the shell/cage/augment, and sitsflush or recessed with respect to an inner surface of theshell/cage/augment, so as to not protrude into the inside portion of theshell/cage/augment where a liner might be seated. The adapter 502 mayhave an expanding tapered or flared head 504 (e.g., frustoconical) thatprotrudes outwardly from the shell and engages an undercut slot, blindor through-slot, or a tapered aperture in the mounting member oraugment. For example, adapter 502 includes an expanding tapered orflared head 504 that engages undercut slot 508 of augment 500. Theadapter 502 may be entirely or partially cannulated and may benon-threaded, threaded partially, or threaded all the way through itslength. The expanding tapered or flared head 504 of the adapter 502 maybe made bifurcated so as to have two or more arm portions 505 and 506that are configured to move away from each other to expand the head 504and create a locking interference between the expanding head 504 and theundercut slot or tapered aperture 508. A small expansion member 510, along bone screw (not shown), or any other suitable fastening member maybe threadably received in the adapter 502 such that when the expansionmember 510, long bone screw, or other fastening member threads into thebifurcated head portion 504, the arms 505 and 506 of the head portion504 expand and frictionally engage the walls of the slot or aperture 508to lock augment 500 to the shell/cage 600 or other augment. A mountingmember may similarly locked to an acetabular shell or cage 600 or anaugment. The head 512 of the expansion member 510, long bone screw, orother fastening member may lie flush with, or slightly recessed from theinside (e.g., concave) surfaces of the shell/cage/augment, so that aliner may be properly seated.

FIG. 9 shows an insertion opening 516 in a shell 518 adapted to receivefeatures of the adapter system of FIG. 8 according to some embodiments.FIG. 10 shows a side cross-sectional view of an adapter 520 in placewithin the shell 518 and an augment 522, used to secure the twocomponents to one another. As shown, the adapter 520 may have afrustoconical head 524, and specifically, may have a head 524 that isbifurcated and expandable. The head 524 of the adapter 520 may bereceived in an augment 522 or any other first component (e.g., amounting member) that is desired to be coupled or otherwise secured to asecond component (e.g., an acetabular shell or cage). The augment 522may have a J-slot (e.g., as shown in more detail in FIG. 8), a dovetailconfiguration, or may have any other appropriate shape, such as anundercut design, or any other appropriate track-type slot or groove.This feature may extend to the upper edge of augment 522 or firstcomponent (e.g., as shown in FIG. 8 where slot 508 extends to uppersurface 514 of augment 500) or it may be positioned in the side wallonly of the augment 522 or first component (e.g., as shown in FIG. 2where track 462 is provided through surfaces 463 and 469 of shell 460).

In use, the adapter head 524 slides into or is otherwise positioned inthe slot/track/undercut. The adapter tail end 526 may extend slightlyfrom the augment 522 or first component and extend toward and slightlyinto an insertion opening in the shell 518 or second component. Asdiscussed above and shown clearly in FIG. 10, it is preferable that theadapter tail 526 not extend completely into the internal cavity of theshell 518 or second component so that a liner 528 may be used withouthaving the liner 528 directly abut or otherwise contact the adapter 520.Once positioned, an expansion member 530 is inserted into the adapter520 to cause the bifurcated head 524 to expand and lock, plug, orotherwise securely lodge the adapter 520 in the desired location.

FIGS. 11 and 12 illustrate an example of a prior mounting member oraugment 531 adapted for securement to a shell 533 as disclosed in U.S.Patent Application Publication No. 2007/0093133, entitled “FixingAssembly,” which is incorporated by reference herein in its entirety.

FIGS. 13-15 illustrate various embodiments of an improvement of thedevices shown in FIGS. 11 and 12. A mounting member or augment may beprovided with an opening having multiple fixed directional threadedscrew holes. For example, mounting member or augment 540 of FIG. 13includes an opening 542 having a plurality of fixed directional threadedscrew holes 544. In the specific embodiments shown, there are threefixed directional threaded screw holes (e.g., screw holes 544), but itwill be understood that more or fewer holes may be provided. The holesmay be fixed in various orientations in space with respect to eachother. The holes may be spaced apart from each other as shown by holes546 in FIG. 15. The holes may intersect radially as shown by holes 544in FIG. 13. The holes may be positioned linearly as shown by holes 548in FIG. 14. In use, a protrusion member that extends from a mountingmember or augment is received in rotating engagement by a round blindundercut recess on an acetabular shell, cage, or augment as shown inFIG. 11. Alternatively, the protrusion member may be received in anundercut track (e.g., as shown in FIGS. 2 and 3) provided on anacetabular shell, cage, or augment. As shown, the projection may bebi-forked in configuration to facilitate its expansion when one or morescrews or other fastening members are inserted through one or more ofthe threaded screw holes in the mounting member or augment. Theprotrusion on the mounting member or augment is generally configured toexpand upon partial screw insertion and is also generally configured tosecure and lock the mounting member or augment to the shell/cage/augmentin a desired relative spatial orientation, regardless of whether or notthe screw secures purchase within the bone.

FIG. 16 illustrates a mounting member or augment 550 according tocertain embodiments that may be used for coupling to an acetabularshell, cage, or other augment having a round blind undercut on theshell, one example of which is shown in FIG. 11. Alternatively, aspreviously mentioned, the protrusion member 552 may be received in anundercut track (e.g., as shown in FIGS. 2 and 3) provided on anacetabular shell, cage, or augment. As shown in FIG. 16, an expandableor deformable spherical ball member 554 is adapted to be positionedwithin, located inside, or otherwise captured within an opening 558 in asplit or bifurcated mounting member or augment 550 and capturedtherewithin. The ball member 554 may be undersized so as to expand whenan expansion member (e.g., screw 556) or other fastener is insertedtherein. Alternatively, the ball member 554 may be formed of adeformable material to allow the ball 554 to expand upon insertion of anexpansion member (e.g., screw 556) or other fastener. Moreover, the ballmember 554 may be split to facilitate expansion of the ball member 554.The ball member 554 is generally captured within, secured to, orotherwise operable with the mounting member or augment 550 so as to forma ball joint.

The ball member 554 may have a deformable smooth bore which isultimately deformed to be threaded by the screw fastener duringinsertion. Alternatively, the ball member 554 may comprise a threadedbore which is slightly undersized in inner diameter with respect to theinserted screw. Alternatively, the bore in the ball member 554 may besmooth and the ball member 554 expanded when engaged by an expansionmember or other fastener. In some instances, as shown, a screw 556 orother fastener may be provisionally positioned adjacent an aperture ofthe cannulated ball member 554, and then oriented to a desired spatiallocation and angulation with respect to a patient's anatomy forinsertion into adjacent pelvic or other bone. The expansion member(e.g., screw 556), long bone screw, or other fastener may be used as alever to move the ball 554 at any angle relative to the mounting memberor augment 550 and then inserted to secure bone purchase.

When the screw or fastener 556 passes through the aperture in the ball554, the ball 554 spreads open or deforms via the aforementionedundersized, deformable, or expandable means. In this instance, the ball554 expands, and in turn, also further expands the mounting member oraugment 550, which may be bifurcated, one example of which is describedabove. When the mounting member or augment 550 is expanded, theprotrusion member 552, shown here as a generally flared and bifurcatedfrustoconical projection, expands within and may lock into a round,blind undercut recess or undercut groove in the shell/cage/augment inthe desired angular spatial orientation. The mounting member or augment550 is generally configured to allow fixing of itself to theshell/cage/other augment regardless of whether or not the screw 556secures purchase within the bone. Moreover, the ball member 554 capturedwithin the mounting member or augment 550 also allows the screw 556 tobe inserted in any orientation relative to both the mounting member oraugment 550 and the shell/cage/other augment.

In some embodiments, such as those shown in FIGS. 17 and 18, an optionalrotatable inner cylinder insert member may be used. The cylinder may besplit along its length and may have one or more threaded bores extendingalong its length at one or more various angles, offsets, andeccentricities for engagement with a long bone screw or other fastener.For example, as shown in FIG. 17, a single bore 566 may be provided in acylindrical insert 564, the bore 566 having a smooth outer bearingsurface 568 that is angled and offset. The insert 564 shown is capturedwithin the mounting member or augment 564 by a knurl, step, flange, orlip 567 so as to be rotatable with respect to the mounting member oraugment 560, but not axially displaceable from the mounting member oraugment 560. When the screw or fastener 569 is inserted into the bore566, the insert 564 expands, and in turn, expands a projection member562 on the mounting member or augment 560 or alternatively oradditionally expands the entire mounting member or augment 560. Theprojection member 562 may expand within the round blind undercut on theshell, cage, or other augment shown in FIG. 11, or alternatively mayexpand within an undercut groove within said shell, cage, or otheraugment as shown in FIGS. 2 and 3.

FIG. 18 depicts a mounting member or augment 570 that is similar to theembodiment shown in FIG. 17, but instead, is configured for use with apolyaxial screw or fastener 576 having a smooth rounded head 577. Inthis exemplary embodiment, the inner cylindrical insert 574 is notsplit, but is instead provided as a larger diameter, externally-threadedbody configured to be received in a smaller diameter threaded bore 571in the mounting member or augment 570. The inside of the cylindricalinsert 574 has one or more “hourglass”-shaped bores 578, for instance,those that can be used with polyaxial screw heads having rounded orspherical screw heads. Various examples of polyaxial locking systems andmethods are shown and described in U.S. Patent Application PublicationNo. 2002/0147499, entitled “Locking Systems for Implants,” U.S. PatentApplication Publication No. 2008/0300637, entitled “Systems and Methodsfor Using Polyaxial Plates,” and U.S. Provisional Patent Application No.61/178,633, entitled “Polyaxial Fastener Systems and Methods,” all ofwhich are intended for potential use in connection with the describedsystems and are incorporated by reference herein in their entireties.

The bore 578 may comprise portions engageable with threads of thepolyaxial screw 576, or may contain deformable tabs in regions proximatethe head 577 for use with threaded heads. The angle of the screw orfastener 576 can be varied within the bore 578 of the cylindrical insert574. Regardless of whether or not the polyaxial screw 576 is insertedinto the bore 578, the mounting member or augment 570 is positivelysecured and locked to the shell/cage/augment in a desired spatialorientation and angulation due to the expansion of the projection member572 or the mounting member or augment 570 as a whole. This occurs, forexample, after inserting and threadably engaging the cylindrical insert574 with an undersized threaded recess (e.g., bore 571) provided in themounting member or augment 570.

FIGS. 19-35 show certain embodiments for attaching mounting members oraugments to an acetabular shell, acetabular cage, or other augment.Disclosed is an apparatus and method for attaching the acetabularmounting members or augments to shells, cages, and other augments withan amount of adjustability. A kit of different augments may be providedfor use with the same acetabular shell, cage, or augment. Relativespatial adjustments between the mounting member or augment position andthe shell/cage/augment may be made with multiple degrees of freedom. Themounting members and/or augments may be attached and subsequentlypermanently and irremovably secured and locked to the shell/cage/augmentprior to or after its insertion into a prepared acetabulum and/orsurrounding bone voids.

In certain embodiments shown in FIG. 19, a mounting member 580 oraugment member 582 is provided with a dovetail feature 581 and 583 (thatmay be male or female), respectively, to connect it to an acetabularshell or cage 584 (or, in some embodiments another augment) having theother complementary mating female or male dovetail feature 586. In theembodiment shown, the complementary feature 586 on the shell 584 is aJ-shaped track or J-slot, but it will be understood that any matingfeatures or configurations may be used. In the specific embodimentdescribed, the dovetail feature 586 is configured to allow the mountingmember 580 or augment member 582 to rotate and/or translate with respectto the shell 584 in a semi-locked state. The semi-locked state generallyallows some independence of movement between the two pieces, which canbe desirable to allow a surgeon to toggle between relative positions orotherwise continue to position and adjust the members. Such asemi-locked or loose connection can be particularly useful for revisionsurgeries.

The mounting member 580 or augment member 582 may be provided in anumber of various shapes, sizes, textures, and configurations configuredto fill bone defects and voids of varying degrees and locations withrespect to a patient's anatomy. For instance, an implant may comprise aflange member that does not necessarily serve to fill a bonevoid/defect, but is instead configured to couple with a bone surface.Dovetail features according to FIGS. 19-35 generally mate by providing aflared male member (e.g., member 581 or 583) that is configured toslidingly engage one or more complementary female members such as one ormore separated or intersecting undercut grooves or recesses (e.g.,member 586). The undercut grooves or recesses may be provided on eithercomponent or vise versa, without limitation. A third member, for examplean expansion member (e.g., setscrew, fastener, rivet, wedge, pin, cam,long bone screw, or any other fastener), may further be provided andused to securely lock the two pieces together to form a locked assembly.In some instances, the third member will engage one or more portions ofthe dovetail features to cause the male member to expand in the femalemember.

In other instances, for example, as shown in FIGS. 20 and 21, a fastenersuch as a setscrew may be inserted through a male portion 588 of thedovetail features to move the male member 588 away from a blind portionof the female member 589, thereby spreading the two pieces such thattapered surfaces of the dovetail features frictionally engage eachother.

FIGS. 22-26 illustrate some embodiments wherein one or more lockingchocks are distally-connected to a surgical cable and are configured tobe received and/or captured within a portion of a mounting member oraugment. For example, FIGS. 22 and 23 show a locking chock 590distally-connected to a surgical cable 592 and positioned within aportion of augment 594. The cable 592 may be introduced through athrough-bore in a mounting member or augment (e.g., bore 596 of augment594) and tightened via a clamping device. The chock 590 is shaped tocomplement a tapered hole or an undercut groove or recess provided in anacetabular shell, cage, or other augment (e.g., undercut recess orgroove 602 of FIG. 24). When the surgical cable 592 is tightened aroundthe mounting member or augment adjacent bone or to any other platingstructures, the chock 592 is pulled toward the undercut surfaces of thetapered hole undercut groove/recess and is expanded by an expansionmember 598, for example, by a ball crimped to a distal portion of thesurgical cable or any of the other expansion members described herein.The chock 590 may engage the undercut groove or recess. As shown inFIGS. 24 and 25, an internal portion of a chock 604 may have an angledor inclined surface 600, which is adapted to receive an expansion member606.

In use, the chock rides along the cable and once positioning is desired,the wings of the chock may be forced apart for securement. For example,wings 595 and 597 of chock 590 shown in FIG. 23 may be forced apart forsecurement. When the cable is tightened, this can (a) pull the augmenttowards the shell/cage/other augment and (b) pull the ball or otherexpansion member at the end of the cable inside the chock so that thewings will expand and the chock will be secured in place. For example,when cable 601 of FIG. 24 is pulled in the direction of arrow 608, thiscan pull expansion member 606 inside the chock 604 so that the wings 605and 607 of chock 604 expand, thereby securing the chock 604 in place.

Alternatively, while not shown, the chocks may be separate piecesattached to the surgical cable at different portions and provided withinclined surfaces that ride together to facilitate expansion andfrictional engagement with the tapered hole or undercut groove/recess.The one or more locking chocks may be oblong for easy insertion into theundercut groove or recess. Once the cable is pulled tight, it may beused as cerclage cable or K-wire and tightened around bone or otheranatomical structures, keeping the mounting member or augment attachedto the shell, cage, or other augment.

Alternatively, as shown in FIG. 26, the cable 610 may be tensioned usinga cable tensioning device provided on the mounting member or augment614. For instance, as shown, a tensioning screw member 612 maythreadingly engage a female thread 616 located in the mounting member oraugment 614. As the tensioning screw member 612 is turned, the cable 610is pulled into tension, thereby moving an expansion member (e.g., acrimped ball) against inner inclined surfaces located on the one or morelocking chocks such as inclined surface 600 of chock 604. When theexpansion member (e.g., expansion member 606) reaches a point ofinterference with the one or more locking chocks, the tensioning screwmember may be turned further to spread the chocks apart and lock themounting member or augment to the shell, cage, or other augment via atightened dovetail joint.

FIGS. 27-29 illustrate some embodiments wherein a mounting member oraugment 628 may be attached to an acetabular shell, cage, or otheraugment 629 using a separate expandable chock member 620 and anintermediate connecting member 622. The intermediate connecting member622 serves to temporarily loosely couple the mounting member or augment628 to the shell/cage/augment 629, and also serves to expand theseparate chock member 620 and lock the two components together. In someembodiments, it is preferred that the separate expandable chock member620 is provided as a generally frustoconical portion or a male portionof a dovetail connection. The separate expandable chock member 620 maybe inserted into and captured within an undercut recess, groove, ortrack (e.g., undercut recess, groove, or track 624) in an acetabularshell, cage, or other augment 629. In some embodiments, the separateexpandable chock member 620 is movably captured and may be positioned atvarious locations and orientations within said undercut recess, groove,or track.

The mounting member or augment 628 is then placed adjacent to theshell/cage/other augment 629, and the intermediate connecting member 622inserted through an aperture, opening, or recess 626 in the mountingmember or augment 628 to engage an undersized or tapered female thread627 in the separate expandable chock member 620. The mounting member oraugment 628 may be moved to a desired position relative to theshell/cage/augment 629 by virtue of the loose connection and undercutrecess, groove, or track, and then locked in a desired relative spatialorientation by engaging the intermediate connecting member.

In the embodiment shown, the intermediate member 622 is provided as aheaded bolt that threadingly engages the separate expandable chockmember 620 to expand the separate expandable chock member 620. When theseparate expandable chock member 620 is fully expanded, a frictionaldovetail locking connection is achieved, which locks the mounting memberor augment 628 to the shell/cage/other augment 629 in the desiredrelative spatial orientation.

FIG. 30 illustrates an alternative embodiment to FIGS. 27-29, which issimilar to the embodiment shown in FIGS. 6 and 7. A small expandingelement 630 is provided within an aperture, opening, or recess 632 in amounting member or augment 634 configured to be loosely attached andlocked to an acetabular shell, cage, or other augment 636. The mountingmember or augment 634 includes a male portion of a dovetail. The maleportion of a dovetail may be formed by a deformable or expandableprotrusion 638 which may be bifurcated and/or initially flared outwardlyin an un-deformed/unstressed state. Alternatively, while not shown, insome embodiments, the expandable protrusion 638 may be provided as agenerally cylindrical member which can be first introduced into anundercut recess, groove, or track, and then expanded within saidundercut recess, groove, or track by the expanding element in order toprovide a locking function between the mounting member or augment andthe shell/cage/augment. As shown in FIG. 30, the expanding element 630may be provided as a small tapered setscrew which engages acomplementary tapered or otherwise undersized thread 640 inside the maleportion of a dovetail. A flexible driver 642 may be used to access thesmall expanding element 630. Upon torsional engagement with theexpanding element 630, a dovetail locking connection is formed, therebysecuring the mounting member or augment 634 to the acetabular shell,cage, or other augment 638 in a desired configuration and relativespatial orientation.

FIG. 31 shows an alternate and additional feature relating to the cableand chock embodiments of FIGS. 22-30. FIG. 31 shows a ferrule 700 on acable 702 that may be positioned against an augment 704. A tensioningtool 706 may be used to hold the cable 702 tight and the ferrule 700 canbe crimped onto the cable 702. When the cable 702 is pulled tight, thechock (e.g., chock 590 of FIG. 22) engages the dovetail slot and thetension pushes the chock towards or into the augment 704, held in placeby the ferrule 700.

FIG. 32 shows one potential geometry for a receiving portion 650 (suchas an undercut recess, groove, or track) in a shell, cage, or augmentaccording to some embodiments. In this example, the receiving portion isa double J-slot formed by slots 652, 654, and 656. FIG. 33 shows afurther optional geometry, where J-slots are provided in opposingdirections formed by slots 662, 664, and 667.

As shown in FIGS. 33 and 34, any of the mounting members or augmentsshown and described herein may comprise tick marks or other indicia forindicating a positional relationship between itself and the implant towhich it is to be attached. For example, an augment 670 may comprise aplurality of peripheral markings 672 or central markings (not shown) foralignment with markings 661 provided in an acetabular shell or cage 660(or, in some embodiments, another augment). In use, a surgeon mayloosely insert the mounting member or augment (e.g., augment 670) andthe shell/cage/augment (e.g., shell 660) into a patient's bone void,prior to assembling the two. The surgeon may then position bothcomponents and possibly other components to determine the best relativespatial orientation to best fill a volume of the void. The surgeon maythen observe, compare, and note the relative positions of the markingsor indicia between the bodies, thereby receiving repeatable andreproducible information about the desired spatial orientation. Thesurgeon may then remove both bodies from the surgical environment,realign them in the desired spatial orientations (facilitated by themarkings or indicia), and then cement or otherwise secure the two bodiestogether in said desired spatial orientation. Subsequently, theassembled implant may be introduced into the void and the surgerycompleted in a normal fashion.

Moreover, as shown in FIG. 35, mounting members or augments shown anddescribed in the figures contained herein may comprise tacks, spikes,coatings, or textured surfaces 674 so as to improve initial fixation.The geographic locations of said tack, spike, coatings, or texturedsurface structures 674 may be strategically placed on select portions soas to evenly load the implant assembly and obtain the best biologicresponse initially, and over an extended period of time.

FIG. 36 shows a bi-lobe cup or shell 710, which is a shell 710 having alobe 712 extending therefrom. Typical bi-lobe shells are made of solidmaterial, but this embodiment shows a bi-lobe shell 710 having a lobe712 of porous material. The lobe 712 may have some solid portions forreceiving screws other fastening members. As shown, additional augmentmembers 714 may be attached to the lobe 712 of porous material or to thesolid shell 710. Areas of the porous lobe 712 may be provided with areasof solid, non-porous material having apertures or other structures forreceiving and locking to screws, such as polyaxial bone screws.Moreover, the porous lobe 712 may comprise holes 716 extending throughfully porous sections for insertion of bone screws.

FIG. 37 shows two augments 720 and 722 attached together via a fasteningdevice 724 such as a screw or a shape-memory polymer peg according tosome embodiments. It will be understood that although augments areshown, the securement mechanisms described herein may also be used withany type of mounting member, shell, or cage as well. In someembodiments, a peg of shape memory material may extend from one or moreaugments and into a prepared hole in bony anatomy. The shape memory pegmay then be activated (via thermal changes or an applied electriccurrent) and expanded within the prepared hole to fix an augment ormounting member to the patient's bone. Non-limiting examples of furtherfeatures for such shape memory plugs are that they may comprise outertextured surfaces, may be porous, and may comprise barbs, flutes,ridges, grooves, spines, any other suitable features, or combinationsthereof.

FIG. 38 shows an augment 726 with integral spikes 728 according to someembodiments. The spikes 728 may allow the augment 726 to be positionedinitially in bone, without the augment 726 having to be first secured toa shell, cage, mounting member, or other augment or without the use ofbone cement. The augment 726 may be positioned and then impacted orotherwise pressed into a bone void to achieve instant fixation.

FIG. 39 shows other embodiments of an augment 730 having built-insecurement features. Embodiments of this augment may have one or moreintegral spikes, barbs, screws, or other fasteners pre-positionedtherein. For example, augment 730 includes integral fastener 732 whichmay be a spike having barbs 734. When the augment 730 is positioned asdesired, the surgeon may screw, impact or tack the augment 730 in place,causing the integral fastener 732 to extend and secure bone purchase.One advantage of this embodiment is that is can prevent the surgeon fromhaving to locate and insert separate fasteners. In some embodiments,there is provided a breakable or frangible connector 736 that is shearedonce the fastener 732 has been impacted, twisted, or otherwise activatedby a force or moment. A further advantage of the described embodimentsis that the augment 730 is a one-piece component that can be positionedwithout additional fasteners or other components attached thereto,simplifying some aspects of insertion. Moreover, the surgeon may desireto place the augment 730 first, and then quickly secure it to the otherimplant portions to be used. Integral fasteners which are not utilizedmay be removed by a pulling out force, and breaking the connector.Fasteners such as integral fastener 732 may be configured to connect theaugment to bone or to other implant devices such as other augments,acetabular shells, acetabular cages, and/or bone plates.

FIGS. 40-42 illustrate various augments or porous coating portionscomprising one or more cross-sectional areas 740, 742, and 744 ofreduced material which are “designed” for easy drilling, shaping, andscrew insertion. In some embodiments, a bulk porous structure isprovided with waffle patterns of recesses defined therein. The recessesmay be externally provided, internally provided, or combinationsthereof. External recesses may be created using rapid manufacturing,wire EDM, milling, or other processes. Internal recesses may be createdusing rapid manufacturing (e.g., selective laser sintering with an EOSmachine or EBM process using an Arcam machine), cross-drillingprocesses, any other suitable processes, or any combinations thereof.The areas of reduced cross-section 740, 742, and 744 make it easier fora surgeon to drill through the augments or porous coating portions,orient screws, and burr, mill, cut, break, bend, or otherwise shape witha rotary tool 746 such as the one shown in FIG. 43. Other modificationtools such as reciprocating saws or oscillating saws may be utilized toshape the augments or porous coating portions. Recesses may extend invarious patterns in two-dimensional or three-dimensional space, and mayvary in width, depth, aperture, thickness, density, and length.

FIGS. 44-47 illustrate some embodiments of a connection device forsecuring a mounting member or an augment to an acetabular shell oracetabular cage. Certain embodiments of the connection device comprisean intermediate locking member 750 that may be placed between anacetabular shell or cage and a mounting member or augment, theintermediate locking member 750 configured to provide initial loose andadjustable attachment of the mounting member or augment to theacetabular shell or cage. After or before impaction, the mounting memberor augment position relative to the shell or cage may be adjusted andthen fixed with respect to the shell or cage by engaging a portion ofthe intermediate locking member 750. After the intermediate lockingmember 750 is engaged to lock the adjacent components together againstrelative movement, a liner may be inserted into the shell or cage. Theintermediate locking member 750 may either be a separate portion orintegral to one of the shell, cage, mounting member or augment.

Portions of the intermediate locking member 750 may be low profile andconfigured to be received in and locked within an acetabular shell(e.g., via a threaded, smooth, or tapered screw hole). In the embodimentshown, the intermediate locking member 750 is provided within anacetabular shell as disclosed in the '705 application. Intermediatelocking member 750 may comprise, as shown, a cam locking pin 752 and alocking head screw 754. The mounting member or augment may comprise anundercut recess 759 which has an opening of any appropriate shape, suchas oblong, scalloped, triangular, dovetail, or any other option. Adistal end 756 of the cam locking pin 752 has a complementary shape(oblong, scalloped, triangular, dovetail, or any other appropriatecomplementary shape) and is flared or tapered radially outwardly toengage one or more undercut surfaces forming the undercut recess 759.

As shown in FIGS. 45 and 46, a proximal end 757 of the cam locking pin752 may have a shaft 758 with engageable threads axially-disposedtherein. A locking head screw (shown for example, as locking head screw754 of FIG. 47) is configured to engage the threads on the shaft 758 ofthe cam locking pin 752. The threads of the locking head screw may befemale or male, and the threads of the cam locking pin 752 may be theother of male or female. Locking screws prevent the cam locking pin 752from backing out once properly positioned. During use, the cam lockingpin 752 is positioned within a receiving groove or recess and rotated tolock the cam locking pin 752 in place. The complementary shapes of thedistal end 756 of cam locking pin 752 and a receiving groove or recessallow the cam locking pin 752 to be inserted into the groove or recessin a first orientation and then rotated to a second orientation in whichit cannot be removed from the groove or recess.

The shaft portion 758 of the cam locking pin 752 may be provided withone or more flats on the outside (e.g., a hexagonal outer cross sectionfor the shaft) to allow turning of the cam. Alternatively, a cruciformrecess or hexagonal recess or other driving structure may be provided onthe cam locking pin 752. In some embodiments, the female thread in thecam locking pin 752 may be substituted for threads on the outside of theshaft 758 of the cam locking pin 752 which engage a partially cannulatedlocking screw having an internally-threaded aperture extending axiallythrough the shaft of the locking screw. In such latter embodiments,outer portions of the locking screw may be smooth. The head 755 of thelocking head screw 752 may alternatively be rounded for polyaxialmovement (exemplary polyaxial locking options are provided in moredetail below) within the hole in the acetabular shell or cage. It willbe understood by those of ordinary skill in the art that the connectionshown in the figures may also be used to connect augments or mountingmembers together, without limitation.

FIGS. 48-50 illustrate some embodiments wherein a mounting member oraugment, for example, as disclosed in FIGS. 44-47, is provided with anelongated undercut groove which is configured to receive a cam lockingpin. The elongated undercut groove allows the mounting member or augmentto be radially adjusted in space and locked in an orbital positionaround a corresponding acetabular shell or cage. In some embodiments,portions of the mounting member or augment proximate the elongatedgroove may be made solid, rather than porous for strength, and outerregions of the mounting member or augment may be smooth, textured,coated (e.g., hydroxyapatite), porous, or combinations thereof in orderto encourage biologic fixation and ingrowth in select regions.

FIG. 49 illustrates a cross-sectional view of an augment 764 and a camlocking pin 752 being inserted into an elongated undercut groove 768 ofthe augment 764 in an insertion position. The cam locking pin 752 ispositioned into the groove 768 by rotating the cam locking pin 752 alongits axis such that the insert width 762 of the distal end 756 of the camlocking pin 752 (as shown in FIGS. 44-46) fits through the insert width770 of the elongated undercut groove 768. FIG. 50 illustrates across-sectional view of the augment 764 with the cam locking pin 752locked into the elongated undercut groove 768 of the augment 764 in alocking position. In the locking position, the cam locking pin 752 maygenerally be rotated along its axis between 50 and 130 degrees,preferably around 90 degrees (i.e., a “quarter-turn”). The locking width760 prevents the distal end 756 of the cam locking pin 752 from fittingthrough the insert width 770 of the elongated undercut groove 768. Insome embodiments, cam locking pin 752 may be symmetrical and may have aflared end (e.g., distal end 756) comprising a generally frustoconicalsurface, and the undercut groove 768 in the augment 764 (or, in someembodiments, an undercut groove in a mounting member) may have one ormore enlarged openings to receive the flared end of the cam locking pin752. In such alternative embodiments, a locking screw (e.g., lockinghead screw 754 of FIG. 47) may threadingly engage the cam locking pin752 to apply a tensile force to the cam locking pin 752 against anotherimplant such as a mounting member, augment, shell, or cage.

In the embodiments shown in FIGS. 51-54, cleats may be providedproximate to a rim of an acetabular shell, cage, mounting member, oraugment. For example, in some embodiments, one or more cleats 780 and781 may extend or project from a superior aspect of a rim portion 782 ofan acetabular shell 784 as shown. Cleats 780 and 781 may be used tosecure soft tissues to the acetabular shell 784 or may serve as a meansto attach secondary augments or any type of mounting member 786 to theacetabular shell 784. In the particular instance shown in FIGS. 53 and54, a “quarter-turn” fastener connector arrangement is utilized. Thequarter-turn fastener arrangement may comprise, for instance, agenerally T-shaped male member 790 located on one or more regions of anacetabular shell, cage, or augment, and one or more complementary femalemembers 792 located on more secondary augments or mounting members. Theone or more secondary augments or mounting members engage the one ormore male members 790 on the acetabular shell, cage, or augment in onedegree of rotation, and then are rotated by a specified or variablenumber of degrees (e.g., 90 degrees) to lock the one or more secondaryaugments or mounting members to the one or more male members 790. Ofcourse, one of ordinary skill in the art would appreciate that the maleand female members could be reversed to provide the same function. Itshould also be understood that other locking mechanisms may be used.

FIG. 55 further depicts one or more cleat portions 794 located atvarious portions of an acetabular shell or cage 796 (or, in someembodiments, an augment) configured for securing soft tissues. The oneor more cleat portions 794 can be arranged in any particular fashionaround the acetabular shell 796; however, it is preferred that thecleats 794 extend proximally from a rim portion or otherwise away fromthe acetabular shell 796 in order to provide clearance from liner-matingsurfaces, cement mantle surfaces, bone contacting surfaces, and bonyanatomy, for example. Cleat portions 794 may comprise suturing holes,roughened surfaces, clamps, hooks, or biologic coatings, or any otherappropriate protrusions, or combinations thereof, to encourage fixationof the soft tissues to the implant (e.g., acetabular shell 796). Forexample, as shown in the inset of FIG. 55, sutures may be wrapped aroundcleat portion 794 and then secured to surrounding soft tissues.

FIGS. 56-60 illustrate embodiments wherein a mounting member 802 or anaugment 804 may be attached peripherally to an acetabular shell or cage806 via a recess 800 provided proximate a rim portion 808 of theacetabular shell or cage 806. The recess 800 is sized to accept aprotruding insertion portion 810 of the mounting member 802 or aprotruding insertion portion 812 of the augment 804, and the recess 800may extend annularly circumferentially around the rim portion 808 toallow orbital placement of the mounting member 802 or augment 804 arounda periphery of the shell or cage 806. The mounting member 802 or augment804 may be inserted into the acetabular shell or cage 806 before orafter shell/cage impaction or cementing into a prepared acetabulum. Oneor more screw holes in the mounting member (e.g., screw holes 814) oraugment (e.g., screw holes 816) rigidly secure the mounting member 802or augment 804 to the bone and prevent orbital movement of the mountingmember 802 or augment 804 around the shell or cage 806. Screw holes 814and 816 may include conventional holes, locking holes, or slots. Theholes may be threaded, unthreaded, or partially threaded, and may befixed or polyaxial. In some embodiments, screw holes 814 and 816 mayinclude variable low-profile holes that allow for locking at a varietyof angles. Once the mounting member 802 or augment 804 is positioned,the cantilever force pushes the rim 808 of the shell or cage 806 towardbone. The protruding insertion portion of the mounting member (e.g.,portion 810) or augment (e.g., portion 812) provides a hold-down forceto the shell or cage 806 after a screw is inserted through the mountingmember 802 or augment 804 and into surrounding pelvic bone.

FIGS. 56 and 57 show an augment 804 being positioned with respect to anacetabular shell or cage 806. FIGS. 58 and 59 illustrate a mountingmember 802 being positioned with respect to an acetabular shell or cage806. The mounting member 802 is shown as having multiple securing holes814 for use with fasteners. Securing holes 814 may be smooth, tapered,or threaded and may be used with any appropriate fastener, including butnot limited to polyaxial screws. The securing holes 814 through themounting member 802 (or securing holes 816 through the augment 804) maybe positioned at any appropriate angle, as shown, such as parallel tothe member, oblique through the member, or otherwise as desired. Whilenot shown, a honeycomb feature may be placed on outer portions of themounting member 802 or augment 804 to provide spacing for a cementmantle between the mounting member 802 or augment 804 and surroundingbone. Moreover, porous structures, textured surfaces, biologic coatings,or orthopedic meshes may be integrally provided on, or incorporatedbetween outer surfaces of the mounting members 802 or augments 804 andsurrounding bone.

In the embodiments of FIGS. 58 and 59, a recess 800 in the shell or cage806 is defined by a proximally-extending lip 818 such that the mountingmember 802 will sit on bone surrounding the acetabulum. In this way, themounting members 802 will not interfere with the press-fit area betweenthe shell 806 and prepared acetabulum adjacent the acetabular rim 808.Moreover, because the connection is configured to allow mounting members802 to sit on surrounding bone, the surrounding bone does not need to becountersunk or otherwise prepared to receive mounting members 802.

FIG. 60 depicts an acetabular shell or cage 820 comprising an annularprotrusion 822 along a rim portion 824 of the acetabular shell 820. Theannular protrusion 822 may extend partially around (as shown) orentirely around the circumference of the acetabular shell 820, or one ormore protrusions may be provided in any fashion around the acetabularshell 820. The annular protrusion 822 may comprise an annular lip 826defining an annular undercut groove 828 running circumferentially aroundthe acetabular shell 820 proximate the rim portion 824. The annularprotrusion 822 may comprise one or more openings 830 for receivingsutures (e.g., for soft tissue or capsule re-attachment) or fasteners832 such as set screws for contacting and frictionally engaging surfaces(e.g., divots) provided on protruding insertion portions 834 and 836 ofmounting members 840 or augments 838 alike.

Fasteners 832 may be inserted into openings 830 locatedcircumferentially laterally of the insertion portions 834 and 836 toserve as stops for preventing or limiting rotational movement of theattached mounting members 840 or augments 838. The mounting members 840or augments 838 may be secured down to surrounding bone after beinginserted into the annular undercut groove 828 via long bone screws,thereby providing a hold-down force to the acetabular shell or cage 820.The hold-down forces provided may complement the press fit, threadedfit, or cemented fixation between the acetabular shell or cage andsurrounding prepared acetabular bone. In the instance shown, shell 820is provided as a “hooded” shell similar to a cage, and may act as abuttress for a cemented or pressed-in liner to support various linerinclinations in varying degrees of acetabular or pelvic degradation,although it will be understood that these features may be provided onany other type of shell or cage.

In the embodiments shown in FIGS. 61-64, one or more mounting membersand/or augments may be integrally provided with orthopedic mesh todefine one or more mesh mounts or void fillers. FIG. 61 shows a mountingmember 380 having an orthopedic mesh 382. In FIG. 62, the orthopedicmesh portion 382 may be placed on an outer portion 384 of the shell 386between bone, and a cement mantle can fill between the mesh 382. Thecement mantle rigidly connects the mounting member 380 (or, in someembodiments, an augment) to the shell 386 via the surgical mesh 382.Rapid manufacturing techniques may be used to simultaneously create themounting members or augments integrally with the orthopedic meshportion. The mesh 382 may be honeycomb, diamond, or other weave pattern,or any combination thereof, and may come in multiple thicknesses. Meshportion 382 may be oversized, customized for an individual patient,and/or standardized and trimmed by the surgeon to fit a particularpatient's needs. Fasteners of all types may be inserted through one ormore cells of the mesh 382, as well as through the one or more mountingmembers or augments to further secure the implant to bony anatomy. Forexample, as shown in FIG. 61, a first screw 388 may be inserted throughcell 390, and a second screw 394 may be inserted through one of theplurality of screw holes 392 of mounting member 380. Screw holes 392 mayinclude conventional holes, locking holes, or slots. The holes may bethreaded, unthreaded, or partially threaded, and may be fixed orpolyaxial. In some embodiments, screw holes 392 may include variablelow-profile holes that allow for locking at a variety of angles. Softtissues may be reattached using the porosities of the mesh 382 as sutureanchors, or simply as a bioscaffold. If desired, preformed trim linesmay be provided by forming predetermined frangible portions in variousareas of the mesh, in order to help configuration of the device for aparticular patient. For example, as shown in FIG. 63, mesh 400 includesa plurality of trim lines 402 that may be cut to separate the mountingmembers attached thereto, such as mounting members 404. The separatedmounting members 404 and the mesh 400 may then be placed into apatient's hip region 406 as shown in FIG. 64.

FIGS. 65 and 66 illustrate some embodiments of a honeycomb design thatmay be provided on a mounting member or augment in order to controlcement mantle thickness and spacing between said mounting member oraugment and an adjacent acetabular shell, augment, bone, or otherimplant. For example, mounting member 410 of FIG. 65 includes honeycombportion 412 provided on an attachment surface portion 414 of themounting member 410. The honeycomb feature 412 may be provided as anydesired geometric shape. The mounting member 410 (or, in someembodiments, the augment) may comprise one or more securing holes 416for receiving a surgical fastener 418 such as a polyaxial screw,cancellous screw, peg, or other securing device. The securing holes 416may include conventional holes, locking holes, or slots. The holes maybe threaded, unthreaded, or partially threaded, and may be fixed orpolyaxial. In some embodiments, securing holes 416 may include variablelow-profile holes that allow for locking at a variety of angles. Theattachment portion 414 of the mounting member 410 may extend generallyperpendicularly from another portion 415 of the mounting member 410, andmay comprise one or more concave curved surfaces 417 configured to abutan outer portion 422 of an acetabular shell 420, or one or more convexsurfaces (not shown) configured to abut an inner portion of a preparedacetabulum.

The foregoing is merely illustrative of the principles of thedisclosure, and the systems, devices, and methods can be practiced byother than the described embodiments, which are presented for purposesof illustration and not of limitation. It is to be understood that thesystems, devices, and methods disclosed herein, while shown for use inacetabular systems, may be applied to medical devices to be used inother surgical procedures including, but not limited to, spinearthroplasty, cranio-maxillofacial surgical procedures, kneearthroplasty, shoulder arthroplasty, as well as foot, ankle, hand, andextremities procedures.

Variations and modifications will occur to those of skill in the artafter reviewing this disclosure. The disclosed features may beimplemented, in any combination and subcombinations (including multipledependent combinations and subcombinations), with one or more otherfeatures described herein. The various features described or illustratedabove, including any components thereof, may be combined or integratedin other systems. Moreover, certain features may be omitted or notimplemented.

Examples of changes, substitutions, and alterations are ascertainable byone skilled in the art and could be made without departing from thescope of the information disclosed herein. All references cited hereinare incorporated by reference in their entirety and made part of thisapplication.

1. An orthopedic implant system comprising: an acetabular implant havinga track that includes a plurality of slots and an exterior surface; anaugment having a protrusion that moves within the plurality of slots,the augment having a first cam surface that forms an interface with theexterior surface; and wherein the protrusion has an adjustable fastenerthat, upon adjusting, fixes the augment with respect to the implant toimpede further movement.
 2. The orthopedic implant system of claim 1,wherein the augment rotates about the exterior surface.
 3. Theorthopedic implant system of claim 1, wherein the adjustable fastener isa tightening screw that extends through a through-hole in the augment.4. The orthopedic implant system of claim 3, wherein the tighteningscrew, upon tightening, expands the protrusion and thereby tightens theaugment within the track.
 5. The orthopedic implant system of claim 4,wherein the protrusion is flared outwardly.
 6. The orthopedic implantsystem of claim 3, wherein the tightening screw has a head that fitswithin a slot and faces an interior portion of the implant.
 7. Theorthopedic implant system of claim 6, wherein the slot has an interioropening that aligns with the head.
 8. The orthopedic implant system ofclaim 7, wherein the interior opening receives a tightening rod totighten the screw.
 9. The orthopedic implant system of claim 1, whereinthe track includes a dovetail joint that receives the protrusion. 10.The orthopedic implant system of claim 1, wherein the track includes astraight portion and a curved portion.
 11. The orthopedic implant systemof claim 10, wherein the track includes two straight slots and a curvedportion.
 12. The orthopedic implant system of claim 1, wherein the trackincludes a J-shaped slot with a wall of the implant.
 13. The orthopedicimplant system of claim 1, wherein the protrusion is part of anintermediate locking member that is integral to the augment.
 14. Theorthopedic implant system of claim 1, wherein the first cam surface ofthe augment includes at least one trough that receives cement to bindthe augment to the shell.
 15. The orthopedic implant system of claim 14,wherein the augment includes a plurality of projections that form a gap.16. The orthopedic implant system of claim 15, further comprising aflange attached to the augment.
 17. A method of preparing an orthopedicimplant, comprising the step of: providing an implant having a curvedexternal surface and an opening in the surface, the opening having atleast two portions that join at a common region but are separated by anangle of less than 180°; providing an augment having a first surfacethat interfaces with the curved external surface; coupling the augmentand implant by an intermediate locking member; and tightening theintermediate locking member.
 18. The method of claim 17, including thestep of securing the augment to the implant by disposing cement within atrough located on the first surface.
 19. The method of claim 17, furthercomprising the step of rotating the augment with respect to the implantabout the curved external surface prior to tightening the intermediatelocking member.
 20. The method of claim 19, further comprising the stepof moving the intermediate locking member within the opening prior totightening.
 21. The method of claim 17, further comprising the steps ofapplying a fastener to the implant, so that the fastener extendsoutwardly from the external surface, and positioning the augment aboutthe external surface so that the extended fastener fits between twoprotrusions of the augment.
 22. The method of claim 21, wherein theintermediate locking member is tightened with respect to the augment bya screw.